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1. Enrollment Down. Obamacare enrollment again fell short of expectations. Roughly half a million fewer people enrolled in ACA plans than in 2016. [1]  Assuming that at least 10 percent of the 12.2 million who signed up will drop out by failing to pay premiums (typically 13 percent drop out), [2] final enrollment will likely be below 11 million. 

2. CBO projections doubtful.  The Congressional Budget Office’s estimate of insurance coverage under Obamacare vs. the American Health Care Act may be unreliable given that CBO used its 2016 projection that millions more would be covered by Obamacare exchange plans this year. [3] 

3. Fewer “Young Invincibles.” The share of enrollees who are “young invincibles” age 18-34 fell to 27 percent, [4] failing to meet the 40 percent threshold that economists projected would be needed to keep premiums stable. [5]

4. More Seniors. The share of enrollees age 55 and older increased as a proportion of those enrolled. [6] Typically, seniors require more health care services and are more costly to insure. 

5. More premium hikes, fewer insurers on the horizon. With fewer young and healthy enrollees and a greater proportion of older people in the exchanges, the “Obamcare death spiral” of rising premiums and fewer insurers is likely to continue. See a state-by-state breakdown of the “State of Obamacare” here. [7]